Herpes
Genital herpes is an infection by herpes simplex virus (HSV) of the genitals.1 Most people either have no or mild symptoms and thus do not know they are infected.1 When symptoms do occur, they typically include small blisters that break open to form painful ulcers.1 Flu-like symptoms, such as fever, aching, or swollen lymph nodes, may also occur.2 Onset is typically around 4 days after exposure with symptoms lasting up to 4 weeks.1 Once infected further outbreaks may occur but are generally milder.1 The disease is typically spread by direct genital contact with the skin surface or secretions of someone who is infected.1 This may occur during sex, including anal and oral sex.1 Sores are not required for transmission to occur.1 The risk of spread between a couple is about 7.5% over a year.5HSV is classified into two types, HSV-1 and HSV-2.1 While historically mostly cause by HSV-2, genital HSV-1 has become more common in the developed world.16 Diagnosis may occur by testing lesions using either PCR or viral culture or blood tests for specific antibodies.1 Efforts to prevent infection include not having sex, using condoms, and only having sex with someone who is not infected.2 Once infected, there is no cure.2 Antiviral medications may, however, prevent outbreaks or shorten outbreaks if they occur.1 The long term use of antivirals may also decrease the risk of further spread.1 In 2015 about 846 million people (12%) had genital herpes.4 In the United States, more than one-in-six people have HSV-2.7 Women are more commonly infected than men.1 Rates of disease caused by HSV-2 have decreased in the United States between 1990 and 2010.1 Complications may rarely include aseptic meningitis, an increased risk of HIV/AIDS if exposed, and spread to the baby during childbirth resulting in neonatal herpes.1 In males, the lesions occur on the glans penis, shaft of the penis or other parts of the genital region, on the inner thigh, buttocks, or anus. In females, lesions appear on or near the pubis, clitoris or other parts of the vulva, buttocks or anus.2 Other common symptoms include pain, itching, and burning. Less frequent, yet still common, symptoms include discharge from the penis or vagina, fever, headache, muscle pain (myalgia), swollen and enlarged lymph nodes and malaise.8 Women often experience additional symptoms that include painful urination (dysuria) and cervicitis. Herpetic proctitis (inflammation of the anus and rectum) is common for individuals participating in anal intercourse.8 After 2–3 weeks, existing lesions progress into ulcers and then crust and heal, although lesions on mucosal surfaces may never form crusts.8 In rare cases, involvement of the sacral region of the spinal cord can cause acute urinary retention and one-sided symptoms and signs of myeloradiculitis (a combination of myelitis and radiculitis): pain, sensory loss, abnormal sensations (paresthesia) and rash.910 Historically, this has been termed Elsberg syndrome, although this entity is not clearly defined.9 Recurrence After a first episode of herpes genitalis caused by HSV-2, there will be at least one recurrence in approximately 80% of people, while the recurrence rate for herpes genitalis caused by HSV-1 is approximately 50%.11 Herpes genitalis caused by HSV-2 recurs on average four to six times per year, while that of HSV-1 infection occurs only about once per year.11 People with recurrent genital herpes may be treated with suppressive therapy, which consists of daily antiviral treatment using acyclovir, valacyclovir or famciclovir.12 Suppressive therapy may be useful in those who have at least four recurrences per year but the quality of the evidence is poor.12 People with lower rates of recurrence will probably also have fewer recurrences with suppressive therapy.13Suppressive therapy should be discontinued after a maximum of one year to reassess recurrence frequency.13